Providence
Providence
Providence — birlamchi va shoshilinch tibbiy yordamdan tortib pediatriya, onalikni muhofaza qilish, saratonni davolash, neyroxirurgiya va ortopediyagacha bo‘lgan keng ko‘lamli tibbiy xizmatlarni ko‘rsatuvchi notijorat sog‘liqni saqlash tizimi. Uning tibbiy yordam tarmog‘i an’anaviy xizmatlarni virtual qabul va mobil ilova orqali foydalanish imkoniyatlari bilan birlashtirib, bemorlarga o‘z ehtiyojlariga mos tarzda shifokorlar bilan bog‘lanishga yordam beradi. Mehr-shafqat, inson qadr-qimmati, adolat va himoyaga muhtoj jamoalarga xizmat ko‘rsatish tamoyillariga asoslangan Providence genomik profillash va klinik sinovlar kabi tashabbuslar orqali tibbiy tadqiqotlar hamda innovatsiyalarni ham qo‘llab-quvvatlaydi. Tashkilot bemorlar davolanishi natijalarini yaxshilash va tibbiy yordamdan foydalanish imkoniyatlarini kengaytirish uchun hamkorlikda ishlaydigan klinik, operatsion, texnologik va tadqiqot guruhlarini birlashtiradi.

Senior Claims Processing Specialist

Lead audits, compliance, and training across Providence’s healthcare claims operations. Coordinate with health plans, providers, patients, hospitals, and adjudication teams.

Tavsif

  • Oversee internal audits of adjudicated claims and encounters.
  • Check payment runs for accuracy.
  • Create policies and procedures for recurring claims audits.
  • Maintain compliance with health plans, client groups, and administrative contract terms.
  • Develop and lead claims training programs.
  • Update training to reflect changes in policies, procedures, and technology.
  • Promote provider and vendor satisfaction while protecting operational integrity.
  • Coordinate between contracted health plans, patients, hospitals, and the IT department.
  • Provide daily claims compliance guidance and training to Claims Examiners and Adjudication teams.
  • Meet customer-defined quality and responsiveness standards.

Talablar

  • At least five years of professional and facility claims processing experience.
  • Familiarity with applicable state and federal laws governing claim payment and denial timelines.
  • Familiarity with state and federal timeliness compliance rules and regulations.
  • Knowledge of the Provider Dispute Resolution tracking mechanism (AB1455).

Imtiyozlar

  • 401(k) retirement savings plan with employer matching.
  • Medical, dental, and vision coverage.
  • Life insurance.
  • Disability insurance.
  • Paid parental leave.
  • Vacation and holiday leave.
  • Time off for health issues.
  • Voluntary benefits.
  • Well-being resources.
  • Additional compensation may include shift differentials, standby or on-call pay, overtime, premiums, extra-shift incentives, or bonuses.

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